The role of vitamin D receptor (VDR) has been well established and extensively studied in the hair cycle. Its deficiency is also closely linked to several types of alopecia, including alopecia areata, telogen effluvium, and androgenetic alopecia (AGA). Since there is limited research on the correlation between androgenetic alopecia and low serum vitamin D levels, our review aims to find relevant articles and comprehensively present them. A review of the literature was performed to gain insight into AGA. Specifically, PubMed and Google Scholar databases were searched to identify any relevant articles with a focus on androgenetic alopecia, male pattern baldness, and serum vitamin D levels. References within the included articles were also reviewed and taken into the study if found appropriate. All articles that met the inclusion criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcomes data. We found 13 relevant studies that elucidated the relationship between low serum vitamin D levels and androgenetic alopecia and included them in the review. We concluded that serum vitamin D might be a possible parameter for diagnosing the onset and severity of AGA. Vitamin D supplementation has proven to be useful in the regrowth of hair in non-human subjects. Vitamin D could be a valid therapeutic approach, such as topical vitamin D (calcipotriol) seems to be a good treatment option to regrow hair follicles and prevent miniaturization of follicles due to androgenetic alopecia.

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e18824 Background: Owing to the widespread implementation of low-dose CT screening (LDCT), an increasing number of pulmonary nodules are being identified. Per LDCT lung cancer screening protocol, radiologists assign Lung-RADS (LR) scores ranging from 1-4 with L1-2 being at low risk and L3-4 being at intermediate to high risk of malignancy. The Brock model derived from the Pan-Canadian Early Detection of Lung Cancer screening study is a mathematical model that incorporates both clinical (age, sex, family history of lung cancer) and radiological (emphysema, nodule size, location of nodule in the upper lobe, nodule type, nodule count and spiculation) factors to predict the risk of lung cancer, but is not commonly used in the United States. The goal of our study was to estimate whether a higher Brock score can be used to further stratify malignancy potential in patients with LR≥3. Methods: We performed a retrospective analysis at Mercy Catholic Medical Center, where we reviewed LDCT findings of 1090 patients, performed between 1/1/2018 - 6/30/2021 and identified 82 patients with LR≥3. Brock Model was used to calculate the malignancy probability of these pulmonary nodules. All patients were followed until biopsy, resolution of nodule or stability on follow-up imaging. In patients with multiple pulmonary nodules, probability was estimated for the largest nodule. An analysis of area under the receiver operating characteristic curve (AUC) was performed to evaluate efficiency of Brock model in our study population (using GraphPad Prism). We used the British Thoracic Society’s suggested threshold of 10% malignancy risk. Results: 82 patients (43 females and 39 males) were found to have pulmonary nodules with LR≥3. Among these, 10 patients were lost to follow-up and excluded from this study. Out of the 38 patients with LR 4, 16 patients had biopsy-proven lung cancer, 22 patients were found to have benign nodules. Among 34 patients with LR 3, only 3 were found to have lung cancer on follow-up. The mean calculated malignancy risk percentage was 6.69% for benign nodules (n = 51), but 27.14% for malignant nodules (n = 18). The calculated AUC in our study population was 0.85 (95%, CI 0.75-0.95, p < 0.0001). At 10% threshold, sensitivity and specificity were 78.95% and 83.02%, respectively. Conclusions: Based on our data, this model can be used to further assess risk of lung cancer in patients with intermediate to high-risk lung nodules (LR≥3). Similar to the use of Tyrer-Cuzick and Gail models in assessing risk of breast cancer, we may be able to use the Brock Model in predicting malignancy risk of lung nodules. However, a larger study is needed to estimate specific cut-offs. This can potentially lower the need for biopsies in lower risk groups and warrant more aggressive work-up and early diagnosis in higher risk populations.

e13072 Background: Since the advent of Oncotype DX (ODX) breast recurrence score (RS) assay, the use of adjuvant chemotherapy (CT) in the treatment of breast cancer has significantly reduced. This test not only estimates the benefit of CT, but also determines the risk of distant recurrence in patients with early-stage breast cancer with hormone-receptor (ER/PR) positive, human epidermal growth factor receptor (HER) 2-negative, and axillary lymph node negative or positive (1-3 positive nodes) disease. All patients are categorized based on their scores ranging from 0-100 as follows: low (RS≤10), intermediate (RS11-25) and high risk (RS≥26). Further studies proved that adjuvant CT is beneficial in pre-menopausal women with RS 0-25, however offered no benefit to post-menopausal women in the same category. The aim of our study was to assess the implementation of these guidelines in a community hospital in an underserved area. Methods: At Mercy Catholic Medical Center, we performed a retrospective analysis on 303 female patients with newly diagnosed breast cancer, identified between January 2017 – October 2022. We included patients with ER/PR+, HER2-, lymph node negative or positive, who had undergone surgery and were to receive endocrine therapy with or without adjuvant CT. Patients who were lost to follow-up or did not undergo the genetic testing were excluded from the study. We then analyzed the treatment strategies based on RS categories. All patients who did not receive CT was either because it was not indicated (old age, post-menopausal) or patients refused. Results: 81 patients underwent ODX testing among whom, 60.5%, 35.8%, and 3.7% patients were Black, White and Hispanic/Asian, respectively. 1.2%, 9.8%, 18.51%, 34.56%, 35.08% were aged ≤40, 41-50, 51-60, 61-70 and ≥71 years, respectively. Based on the RS, we identified 29.62% in low risk, 56.79% in intermediate risk, and 13.5% in high-risk categories. 100% patients in the high-risk category were prescribed CT and only 7.4% patients with RS 0-25 received CT. 12 patients were found to be lymph node positive, among whom, 3 had RS≥26 and 2 were pre-menopausal, all of whom were prescribed CT. Out of these, 7 were post-menopausal with RS 0-25 and only 1 received CT. Conclusions: Our hospital data suggests that implementation of ODX and adherence to its guidelines has significantly helped avoid CT and its related side effects in the low and intermediate risk categories. Implementation of this cost-effective test has consistently increased in the last two decades and is now an imperative tool in clinical decision-making specially in community hospitals serving underprivileged populations. [Table: see text]

Latest advancements in science lead to drastic improvements in patient health care. Techniques and technology evolved in surgery over the years have resulted in the improvement of patient outcomes by leaps and bounds. Open surgeries previously done for procedures like appendectomy and cholecystectomy evolved into laparoscopic minimally invasive procedures. Such procedures pose few challenges to the surgeons, like lack of tissue feedback and fulcrum effect of the abdominal wall. But training surgeons for such an advanced skill is still following conventional methods. These procedures can be effectively trained using Virtual Reality (VR), which can simulate operations outside the operating room (OR). To maximize the outcomes of VR training, knowledge on various strategies affecting the skills acquisition and retention in VR training is essential. This review collected information from PubMed, EMBASE, Cochrane Library (CENTRAL) databases. Data from the previous ten years are included in the review. This included documents, clinical trials, meta-analysis, randomized controlled trials, reviews, systematic reviews, letters to editors, and grey literature. After an advanced Medical Subject Headings (MeSH) search, we got 59,532 results, and after the application of filters, 189 results showed up. Out of these, studies that were not exclusively relevant to the use of VR in laparoscopic surgery were manually excluded, and a total of 35 articles were included in the study. VR is found to be an excellent training modality with promising outcomes. It helps the surgeons perform the surgery accurately at a faster pace and improves confidence and multitasking ability in OR. Instructor feedback from mentors and deliberate practice of trainees, and early introduction of haptics in VR resulted in the most effective outcomes of the VR training. Box trainers are also compared with VR trainers as they are the cheaper modalities of training. However, this area needs more research to conclude if box trainers can act as a cheaper alternative to VR training providing similar outcomes.

Parkinson's disease (PD) is one of the most common neurodegenerative diseases with a high rate of morbidity. It is associated with dopaminergic neuron loss and is fairly common in the elderly population. Recently, there has been a growing interest in the role of the gut microbiome in the pathogenesis of PD and thus studies addressing the methods to modulate the microbiota are becoming increasingly popular. Fecal microbiota transplant (FMT) is one of these methods and is effective in certain intestinal and extraintestinal conditions. This review aims to talk about gastrointestinal dysbiosis and how the reconstruction of this microbiome via FMT could potentially be used as a treatment modality in the future. We went through various studies and collected data relevant to our topic from the previous five years. The studies selected include reviews, observational studies, animal studies, case reports, and some grey literature. We concluded that although it has great potential as a therapeutic modality in the future, it is limited by several factors such as variability among the results of most clinical studies and the lack of large sample sizes. Therefore, there is a need for high-quality clinical trials with larger sample sizes to gather enough clinical evidence so that FMT can qualify as a widely recommended therapeutic measure.

Stimulant medications including illegal use of Methamphetamine (MA) continues to rise in adolescents and young adults. This study aims to examine mortality trends because of the stimulant overdose in this age group (15 to 34 years). Methods:Age-adjusted mortality data, including 95% confidence intervals and standard errors, were extracted using publicly available multiple causes of death files from the United States Centers for Disease Control Wideranging ONline Data for Epidemiologic Research (WONDER). The data was filtered using International Classification of Disease (ICD-10) codes: F15.0 (Mental and behavioral disorders because of use of other stimulants, acute intoxication), F15.1 (Mental and behavioral disorders because of use of other stimulants, harmful use), T43.6 (Psychostimulants with abuse potential). The trends analysis for 1999 to 2019 was conducted using Joinpoint regression statistical software. Results:The mortality rate has been consistently increasing in the last decade across all races and ethnicities in adolescents and young adults. Non-Hispanic White population had the highest mortality rates (7.6 per 100,000 in 2019) compared with non-Hispanic Black (3.08 per 100,000 in 2019) and Hispanic population (3.33 per 100,000 in 2019). But the annual percent change in mortality was shown to be highest in non-Hispanic Black population (34.3% between 2009 and 2019). Conclusion:The increase in overall mortality rate because of stimulants use reflects the increase of MA use in this age group. The difference in the rate of change shows worsening racial inequality. Public health policies should be implemented to include evidence-based strategies to prevent MA misuse or overdose.

e15037 Background: Next Generation Sequencing (NGS) is a revolutionary test used in advanced malignancies to study specific mutations, define tumor burdens, & design personalized treatment plans based on the target mutations. With this study, our aim is to highlight the role of NGS, especially in a community hospital & emphasize on its implementation as a standard of care in advanced metastatic cancers. Methods: We retrospectively reviewed the charts of 51 patients after IRB approval, aged > 18 years with no specific demographic restrictions, with advanced malignancies who had NGS at Mercy Catholic Medical Center, PA. Results: Of 51 patients, 25 were males & 26 were females, 44 patients had positive results on NGS. 100 types of mutations were identified & 338 mutations in total were found. Lung cancer had highest mutations (41.17%-21/51), followed by colon (25.49% - 13/51), breast, ovarian & endometrium (13.72% 7/51), & the rest comprised of GI malignancies & prostate cancers. Of 100 mutations, 32% (32/100) had actionable targets & received NGS directed chemoimmunotherapy, 22% (22/100) mutations had experimental chemo-immunotherapeutic drugs, & 49% (49/100) had no specific NGS directed therapy actionable/target mutation. The most common (1,2,3) & some rare mutations (4,5 and 6) with directed immunotherapy noted on NGS are listed in Table 1. Conclusions: As per our study, 86.27% of the sample size showed positive results on NGS. 32% of these mutations had NGS directed chemoimmunotherapy against these target mutations. In contrary to standard treatment regimens, a personalized treatment plan was developed for these patients, thereby curbing further progression & improving survival in patients with advanced cancer. For example, a patient with stage IV colon cancer who was progressing on the standard treatment with FOLFOX (Folinic acid, flurouracil and oxaliplatin), was started on Ivosedenib, after undergoing NGS and showed marked improvement clinically and radiologically. 29 out of 43 guidelines for various malignancies established by National Comprehensive Cancer Network highlight the significance of NGS. With this study, our goal is to emphasize on the utility of NGS in patients with advanced cancer & the need for it to be incorporated as the standard of care, in small & mid-tier community hospitals, which would need a devised plan for its implementation. [Table: see text]